Table 5.
Percent Mediation of 3+ vs. 0–2 Ideal Cardiovascular Health Metrics by Aldosterone, Stratified by Age, Sex, and Estimated Glomerular Filtration Rate.
| Mediation analysis | % mediated | Estimated effects | p-value* | Estimated difference Men – Women or ≤median - >median |
||
|---|---|---|---|---|---|---|
| ADEa | ACMEb | ADE | ACME | |||
| All participants | 6.98 | 12.21 (3.87, 22.33) | 0.9 (0.23, 1.78) | 0.006 | ||
| Sex | ||||||
| Men (N = 990) | 10.7 | 1.46 (−6.84, 11.27) | 0.84 (−0.002, 2.13) | 0.644 | −29.65 (−53.82, −12.97) P = 0.02 |
−0.32 (−2.36, 1.88) p = 0.68 |
| Women (N = 1801) | 2.76 | 31.34 (12.55, 54.57) | 0.94 (−0.13, 2.46) | 0.1 | ||
| Age (median=53) | ||||||
| ≤median (N = 1389) | 11.7 | 4.98 (−4.84, 16.27) | 1 (0.05, 2.5) | 0.29 | −22.5 (−47.1, −3.39) P<0.001 |
0.38 (−1.79, 2.74) p = 0.72 |
| >median (N = 1402) | 1.67 | 26.99 (9.31, 50.72) | 0.47 (−0.64, 1.84) | 0.38 | ||
| Estimated Glomerular Filtration Rate (median=97 ml/min per 1.73 m2) | ||||||
| ≤median (N = 1395) | 6.17 | 22.57 (6.84, 42.63) | 1.53 (0.14, 3.41) | 0.036 | 14.06 (−2.67, 34.57) p = 0.14 |
2.05(−0.17. 4.5) p = 0.08 |
| >median (N = 1396) | 0.44 | 7.45 (−2.33, 19.02) | 0.08 (−0.39, 0.65) | 0.78 | ||
⁎
p-value for mediated effects.
a
Average Direct Effect.
b
Average Causal Mediation effect
Interpretation: Overall, 6.98% of the effect of ideal cardiovascular health (3+ vs. 0–2) on incident diabetes are estimated to be mediated by aldosterone (p = 0.006). Examining the interactions, the average direct effects were significantly different by sex and age groups (p = 0.020 and <0.001, respectively), but the average causal mediation effects were similar. The mediation effect of aldosterone is larger for patients with EGFR below the median (p = 0.036).